title: A risk prediction score for invasive mold disease in patients with hematological malignancies.
abstract: BACKGROUND
  A risk score for invasive mold disease (IMD) in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis.
  
  
  METHODS
  We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008) to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012.
  
  
  RESULTS
  Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD) were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of < 6 discriminated patients with low (< 1%) versus higher incidence rates (> 5%) of IMD, with a negative predictive value (NPV) of 0.99, (95% CI 0.98-0.99). During 2009-2012, patients with a calculated risk score at admission of < 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores > 6 (0.9% vs. 10.6%, P <0.001).
  
  
  CONCLUSIONS
  An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate "screening-out" of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.
authors.affiliation: Institute of Hematology, Department of Hematology and Clinical Oncology, "Lorenzo e Ariosto Seràgnoli" S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Stanzani
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Mauro
authors.initials: M
authors.lastname: Fiacchini
authors.forename: Paolo
authors.initials: P
authors.lastname: Ricci
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.forename: Simone
authors.initials: S
authors.lastname: Ambretti
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Nicola
authors.initials: N
authors.lastname: Vianelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D005658:Fungi / Q000187:drug effects; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology*; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents